Advanced myocardial characterization in hypertrophic cardiomyopathy: feasibility of CMR-based feature tracking strain analysis in a case-control study

Abstract

Objectives

This study aimed to evaluate the feasibility and reproducibility of using cardiovascular magnetic resonance feature tracking (CMR-FT) for analysis of bi-ventricular strain and strain rate (SR) in hypertrophic cardiomyopathy (HCM) patients as well as to explore the correlation between right ventricular (RV) and left ventricular (LV) deformation.

Methods

A total of 60 HCM patients and 48 controls were studied. Global and segmental peak values of bi-ventricular longitudinal, circumferential, radial strain, and systolic SR were analyzed. Pearson analysis was performed to investigate the correlation of RV and LV deformation. Intra-observer and inter-observer reproducibility were also assessed.

Results

LV mass in the HCM group was significantly higher than that in the control group. LV end-systolic and end-diastolic volume and RV end-systolic and end-diastolic volume in the HCM group were all significantly lower than the correlated parameters in the control group (p < 0.001, respectively), whereas no statistical difference was found in ejection fraction (p > 0.05). Global longitudinal strain (GLS), global longitudinal strain rate (GLSR), global circumferential strain (GCS), global circumferential strain rate (GCSR), global radial strain (GRS), and global radial strain rate (GRSR) of the LV and RV were all significantly lower than the control group, and segmental strain and SR were also true (p < 0.001, respectively). Bi-ventricular strain and SR measurements were highly reproducible at both intra- and inter-observer levels. Additionally, Pearson analysis showed RV GCS, GLS, and GRS positively correlated with LV GCS, GLS, and GRS (r = 0.713, p < 0.001; r = 0.728, p < 0.001; r = 0.730, p < 0.001, respectively).

Conclusions

CMR-FT is a promising approach to analyze impairment of global and segmental myocardium deformation in HCM patients non-invasively and quantitatively.

Key Points

CMR-FT allows for advanced myocardial characterization with high reproducibility.

As compared with controls, HCM patients have significant differences in CMR-FT strain analysis while ejection fraction was similar.

CMR-FT may serve as an early biomarker of HCM in subjects at risk.

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Abbreviations

CMR-FT:

Cardiovascular magnetic resonance feature tracking

EF:

Ejection fraction

GCS:

Global circumferential strain

GCSR:

Global circumferential strain rate

GLS:

Global longitudinal strain

GLSR:

Global longitudinal strain rate

GRS:

Global radial strain

GRSR:

Global radial strain rate

HCM:

Hypertrophic cardiomyopathy

LV:

Left ventricular

pEF:

Preserved ejection fraction

RV:

Right ventricular

SR:

Strain rate

SSFP:

Standard steady-state free precession

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Acknowledgments

The authors would like to specially thank Professor Lingzhi Hu, M.D. (from united imaging healthcare), for his expert advices for the design of our experiments and the image analyses. In addition, we thank Assistant Professor YingFeng Tu, Ph.D. (Cardiology Department of the 2nd Harbin Medical University Affiliated Hospital, Harbin, China), and QunShao, Ph.D. (Cardiology Department of the 3rd Harbin Medical University Affiliated Hospital, Harbin, China), for their assistance with the preparation of this manuscript.

Funding

This study has received funding by the National Natural Science Foundation of China General Projects (81571740) (KW), Scientific Research Grant of Heilongjiang Province Natural Science Foundation for Returned Chinese Scholars (LC201436) (KW), Postdoctoral Special Scientific Research Grant of Heilongjiang Provincial Government (LBH-Q17104) (KW), Distinguished Young Scientist Funding of Harbin Medical University Affiliated Tumor Hospital (JCQN2019-02), Key Project of the Climbing Funding of the National Cancer Center (NCC201808B019), Youth Scientific Research Grant of Heilongjiang Province Natural Science Foundation (QC2015127) (LZ), Medical Scientific Research Foundation of Heilongjiang Province Health Department (2014-312) (LZ), and Natural Science Foundation of 2nd Affiliated Hospital Harbin Medical University (KTBS2015-26) (LZ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

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Authors

Corresponding authors

Correspondence to Xiushi Zhang or Kezheng Wang.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Kezheng Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Multicenter study

Additional information

Publisher’s note

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Liping Yang and Lingbo Zhang contributed equally to this work.

Electronic supplementary material

330_2020_6922_MOESM2_ESM.avi

LV circumferential strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the short-axis view in HCM patient. (AVI 5501 kb)

330_2020_6922_MOESM3_ESM.avi

LV radial strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the short-axis view in HCM patient. (AVI 5497 kb)

330_2020_6922_MOESM4_ESM.avi

LV longitudinal strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the long-axis four-ventricular view in HCM patient. (AVI 5728 kb)

330_2020_6922_MOESM5_ESM.avi

RV circumferential strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the short-axis view in HCM patient. (AVI 6447 kb)

330_2020_6922_MOESM6_ESM.avi

RV longitudinal strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the long-axis four-ventricular view in HCM patient. (AVI 5718 kb)

330_2020_6922_MOESM7_ESM.avi

RV radial strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the short-axis view in HCM patient. (AVI 6031 kb)

ESM 1

(DOCX 719 kb)

Video S1

LV circumferential strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the short-axis view in HCM patient. (AVI 5501 kb)

Video S2

LV radial strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the short-axis view in HCM patient. (AVI 5497 kb)

Video S3

LV longitudinal strain is displayed in 4D volume. The movie shows a representative case of LV tracking in the long-axis four-ventricular view in HCM patient. (AVI 5728 kb)

Video S4

RV circumferential strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the short-axis view in HCM patient. (AVI 6447 kb)

Video S5

RV longitudinal strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the long-axis four-ventricular view in HCM patient. (AVI 5718 kb)

Video S6

RV radial strain is displayed in 4D volume. The movie shows a representative case of RV tracking in the short-axis view in HCM patient. (AVI 6031 kb)

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Yang, L., Zhang, L., Cao, S. et al. Advanced myocardial characterization in hypertrophic cardiomyopathy: feasibility of CMR-based feature tracking strain analysis in a case-control study. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06922-6

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Keywords

  • Cardiovascular magnetic resonance
  • Feature tracking
  • Hypertrophic cardiomyopathy